0:01

So case number seven 56 year old female presents for

0:04

screening mammogram.

0:07

So here is her CC.

0:10

And her mlau view and I'm going to point

0:13

out the abnormality, which I really think was an amazing

0:16

call. I barely saw it. But the person that was

0:19

reading in a saw and asymmetry in the CC view

0:22

here. They didn't know where it was.

0:25

And really the point here is what?

0:28

So you're gonna give it a buyer at zero, but my question to you

0:31

is what Imaging. Can you get if

0:34

you see this asymmetry on a cc View?

0:37

In addition to spot compression. What can you do to

0:40

figure out where it is in the breast already know right now is it's

0:43

in the lateral breast and we're not entirely sure if

0:46

it persists. I think it persists there.

0:49

So if you see something on the CC view, but not the envelope you

0:52

what views are you going to get?

0:58

And it rules true lateral tomasynthesis or

1:01

combination of the two.

1:05

Good. I'm happy that it's all over the place. So.

1:09

So the answer when you see something on a cc

1:12

but not the mlo.

1:14

The real answer is rolled and I

1:17

think that you know, it's homo synthesis is kind of getting a way

1:20

of role getting rid of old views,

1:23

but I still think there is a role for them. But in this case

1:26

you could do rolled or tomosynthesis. So either would be

1:29

correct but really A and C is the most correct. Okay. So

1:32

this is a question for you. So, you

1:35

know, it's in the lateral breasts and neither what roles

1:38

you look like if you've never actually seen one in practice.

1:41

The technologists have to get World medial and

1:44

role lateral views and what they're telling you is which

1:47

way they're rolling the superior breath. So

1:50

in this case the role in the superior breast medially and

1:53

the lesion rules laterally, okay,

1:56

it went from here to here.

1:59

And in this case the rolling Superior breath laterally

2:02

and it moves medially like we're seeing it

2:05

better now within the tissue.

2:07

So just thinking in

2:10

your head so we know it's in the outer breasts and now is it in

2:13

the upper outer or the lower outer breast and rolls

2:16

away from the superior breath.

2:19

So what clock positions are you going to have the tech scan?

2:23

So it's telling you it's in the lower outer quadrant

2:26

because it's rolling opposite of the superior breast

2:29

if it rolled with the superior breast, you know, it's in the superior

2:32

breath. So in this case, it's in the lower outer because

2:35

it's well you roll the superior breast medially. It rolls laterally

2:38

and vice versa.

2:39

So we know it's in the lower outer breath. So in the right lower

2:42

outer breath, it's going to be six o'clock to nine o'clock.

2:45

And there you can see at eight o'clock.

2:48

There isn't a regular hypochoic Mass. That's suspicious.

2:51

It's gonna be a virus for and this

2:54

ended up being an invasive ductal carcinoma and

2:57

dcis. You can see that it's Erp

3:00

our positive her to negative. That's usually the most

3:03

common type of cancer that we get.

3:06

Um, so just wanted you know this this diagram

3:09

which we're going to lose when we go when we when we show

3:12

this image, but this is

3:15

a great diagram and it's really if you don't understand this concept

3:18

take a few minutes to sit and digest it. But basically the

3:21

tech is going to roll the test the superior breath medially

3:24

and laterally and you're going to see if the lesion moves with it or away from

3:27

it. They must indicate which way they're rolling the breast

3:31

Um, and so like I said, if it rolls with it

3:34

is in the superior breath if it rolls opposite, it's in the inferior

3:37

breath and you're going to do the you're going to do roll to use

3:40

on.

3:41

If you see a lesion on the CC view, but not the ml.

3:44

Okay.

3:46

Um, so what do you do if you feel these on the mllo,

3:49

but not the CC and this is the opposite. So

3:52

and when you get it, if you see something on the mllo,

3:55

you're gonna get a true lateral view to see if it drops

3:58

or if it rises.

4:00

And and you're going to do ml better for lateral

4:03

lesions or LM is better for medial lesions. It's

4:06

named from the direction of the

4:09

tubes that it detector. And this helps

4:12

you tell where it is on the CC View and this is a

4:15

great diagram that's going to show you what lesions

4:18

do so if you have some in the CC view,

4:21

I'm sorry. If you haven't on the ml view if it's

4:24

in the medial breath, it's going to rise so muffins rise

4:27

on the true lateral view as opposed to if it's

4:30

in the lateral view, it's in the lateral breast. It's going to fall on

4:33

the true lateral View.

4:35

So muffins rise lead Falls, that's a

4:38

great way to remember it. So if it's a medial it's going to rise if it's

4:41

not if it's in the lateral breast it's going to fall on the

4:44

ml View.

4:45

So medial lesions go up from the ml to

4:48

mlo to ml and lateral lesions go down from the

4:51

amalo to ml.

4:53

So again, if you don't understand that concept take

4:56

a few minutes and just kind of think about that in your head. I promise

4:59

it will make sense.

5:01

So just to give you an example, this is

5:04

a five radenoma. We don't we know exactly where it is. But

5:07

this is the CCU the mlo you and

5:10

the ML and you could see that it rises from the

5:13

mlo to the ml so it's in the medial

5:16

breath. So if you didn't know where something was it would tell you where it

5:19

is.

5:19

So this is a good example of it

5:22

in real life.

5:24

So exaggerated views are some other types of images that

5:27

you can get. If you need to see more

5:30

lateral or medial tissue xccl means

5:33

you're going to pull the it means exaggerated laterally you're

5:36

going to pull the lateral breast tissue out further. That's something

5:39

that's in the lateral View and you want to see it better opposite

5:42

is xccm. You're gonna exaggerated immediately

5:45

if you want to see the more medial breath tissue,